• Robert Winzer, Dieter Fedders, Moritz Backes, Till Ittermann, Matthias Gründling, Birger Mensel, Hanns-Christoph Held, Marie-Luise Kromrey, Jürgen Weitz, Ralf-Thorsten Hoffmann, Robin Bülow, and Jens-Peter Kühn.
• Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl Gustav Carus University, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany. robert.winzer@uniklinikum-dresden.de.
• Cardiovasc Intervent Radiol. 2020 Aug 1; 43 (8): 1148-1155.

PurposeTo investigate the outcome of local intra-arterial papaverine infusion therapy in patients with non-occlusive mesenteric ischemia (NOMI), and factors influencing survival, in comparison with a conservative approach.MethodsFrom 2013 to 2019, patients with NOMI confirmed by imaging were included in a retrospective two-center study. According to different in-house standard procedures, patients were treated in each center either conservatively or interventionally by a standardized local infusion of intra-arterial papaverine into the splanchnic arteries. Thirty-day mortality and factors influencing the outcome, such as different demographics and laboratories, were compared between groups using Kaplan-Meier survival analysis and Cox regression, respectively.ResultsA total of 66 patients with NOMI were included, with n = 35 treated interventionally (21 males, mean age 67.7 ± 12.3 years) and n = 31 treated conservatively (18 females, mean age 71.6 ± 9.6 years). There was a significant difference in 30-day mortality between the interventional (65.7%; 12/35 survived) and the conservative group (96.8%; 1/31 survived) (hazard ratio 2.44; P = 0.005). Thresholds associated with a worse outcome of interventional therapy are > 7.68 mmol/l for lactate, < 7.31 for pH and <  - 4.55 for base excess.ConclusionLocal intra-arterial papaverine infusion therapy in patients with NOMI significantly increases survival rate in comparison with conservative treatment. High lactate levels, low pH and high base excess, and high demand for catecholamines are associated with a poor outcome.Level Of EvidenceLevel III.

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